Winstein--14a
Some of the medical uses of blood and major blood products

http://en.wikipedia.org/wiki/Blood_transfusion
http://en.wikipedia.org/wiki/Maternal_death
http://www.netdoctor.co.uk/diseases/facts/thrombocytopenia.htm
http://en.wikipedia.org/wiki/Thrombotic_thrombocytopenic_purpura
http://en.wikipedia.org/wiki/Anemia
http://en.wikipedia.org/wiki/Sickle_cell_disease
http://en.wikipedia.org/wiki/Hemolytic_disease_of_the_newborn
http://en.wikipedia.org/wiki/Evans_syndrome
http://www.religioustolerance.org/witness5.htm
Thanks to Nathan Natas for the report by Dr. Cassian Yee in the New England
Journal of Medicine. A man's cancer was cured by the injection of cloned white
blood cells--"immunotherapy."
http://www.telegraph.co.uk/earth/main.jhtml?xml=/earth/2008/06/18/scicanc118.xml
http://www.breitbart.com/article.php?id=080618212711.38ht6zq0&show_article=1
Blood transfusion risks and alternatives
Since the JWs leaders propagandize against transfusion use by mischaracteriz-
ing the scriptures (that the scriptures require abstaining from transfusion of
blood and major blood fractions; see pp.1 and 12 to 42) and medical dangers
(making the facts fit the theory to rationalize their prophet playing; see the
entry for 2006 about "How Can Blood Save Your Life?" on p.1a), here is a section
of mainly Wikipedia articles on blood transfusion risks and alternatives.
http://en.wikipedia.org/wiki/Blood_transfusion
http://www.aabb.org/Content
http://www.noblood.org/
Complications and risks
Main article: Transfusion reaction
http://en.wikipedia.org/wiki/Transfusion_reaction
There are risks associated with receiving a blood transfusion, and these must
be balanced against the benefit which is expected. The most common adverse
reaction to a blood transfusion is a so-called febrile non-hemolytic transfusion
reaction, which consists of a fever which resolves on its own and causes no
lasting problems or side effects.
Hemolytic reactions include chills, headache, backache, dyspnea, cyanosis,
chest pain, tachycardia and hypotension.
Blood products can rarely be contaminated with bacteria; the risk of severe
bacterial infection and sepsis is estimated, as of 2002, at about 1 in 50,000
platelet transfusions, and 1 in 500,000 red blood cell transfusions.[10]
Transmission of viral infection is a common concern with blood transfusion.
As of 2006, the risk of acquiring hepatitis B via blood transfusion in the Unit-
ed States is about 1 in 250,000 units transfused, and the risk of acquiring HIV
or hepatitis C in the U.S. via a blood transfusion is estimated at 1 per 2 mil-
lion units transfused.
http://en.wikipedia.org/wiki/Hepatitis
http://en.wikipedia.org/wiki/Hiv
Transfusion-associated acute lung injury (TRALI) is an increasingly recognized
adverse event associated with blood transfusion. TRALI is a syndrome of acute
respiratory distress, often associated with fever, non-cardiogenic pulmonary
edema, and hypotension, which may occur as often as 1 in 2000 transfusions.
Symptoms can range from mild to life-threatening, but most patients recover ful-
ly within 96 hours, and the mortality rate from this condition is less than 10%.
There were 35 deaths due to TRALI in the U.S. in 2006.
http://64.233.169.104/search?q=cache:xGjZ614Ii2wJ:www.unitedbloodservices.org/hospitalnewsletters/2007-06-jun-10.pdf+TRALI+2007&hl=en&ct=clnk&cd=5&gl=us
The AABB response to it, recommending that "blood centers modify the use of
plasma according to the gender of the donor" to help prevent TRALI, is at the
next link.
http://www.smartbrief.com/news/aabb/storyDetails.jsp?issueid=8ED02612-9BBE-427E-95E9-56131199F504©id=81AF79D4-B3CC-47AC-88DC-0AD8E99B28A0&lmcid=
Other risks associated with receiving a blood transfusion include volume over-
load, iron overload (with multiple red blood cell transfusions), transfusion-as-
sociated graft-vs.-host disease, anaphylactic reactions (in people with IgA def-
iciency), and acute hemolytic reactions (most commonly due to the administration
of mismatched blood types).
Blood transfusion substitutes
Main article: Blood substitutes
http://en.wikipedia.org/wiki/Blood_substitutes
As of mid-2006, there are no clinically utilized oxygen-carrying blood substi-
tutes for humans; however, there are widely available non-blood volume expanders
and other blood-saving techniques. These are helping doctors and surgeons avoid
the risks of disease transmission and immune suppression, address the chronic
blood donor shortage, and address the concerns of Jehovah's Witnesses and others
who have religious objections to receiving transfused blood.
A number of blood substitutes are currently in the clinical evaluation stage.
Most attempts to find a suitable alternative to blood thus far have concentrated
on cell-free hemoglobin solutions. Blood substitutes could make transfusions
more readily available in emergency medicine and in pre-hospital EMS care. If
successful, such a blood substitute could save many lives, particularly in
trauma where massive blood loss results.
Thanks to the post by HAL9000 at the Jehovahs Witness Discussion Forum web
site for the next report:
http://www.jehovahs-witness.com/16/143875/1.ashx
Information on Erythropoiesis Stimulating Agents (ESA) (marketed as Procrit,
Epogen, and Aranesp)
FDA ALERT [11/16/2006, Updated 2/16/2007 and 3/9/2007]: FDA is issuing this
alert to provide new safety information for erythropoiesis-stimulating agents
(ESAs) [Aranesp (darbepoetin alfa), Epogen (epoetin alfa), and Procrit (epoetin
alfa)]. Analyses of four new studies in patients with cancer found a higher
chance of serious and life-threatening side effects and/or death with the use of
ESAs. These research studies were evaluating an unapproved dosing regimen, a
patient population for which ESAs are not approved, or a new unapproved ESA.
In another study, patients scheduled for orthopedic surgery had a higher rate
of deep venous thrombosis when treated with Procrit at the approved dose. This
new information is consistent with risks found in two clinical studies in pa-
tients with chronic renal failure treated with an unapproved regimen of an ESA
that were reported in November 2006 and are summarized in the data section be-
low.
All ESAs have the same mechanism of action. As a result, FDA believes these
new concerns apply to all ESAs and is re-evaluating how to safely use this pro-
duct class. FDA and Amgen, the manufacturer of Aranesp, Epogen and Procrit,
have changed the full prescribing information for these drugs. The new product
labeling includes a new boxed warning, updated warnings, and a change to the
dosage and administration sections for all ESAs.
Blood transfusion safety
As mentioned above, the major risks that the patient (donors and receivers)
may have encountered are the transmission of HIV or hepatitis and immunological
transfusion reactions. Most of these problems are risky possibilities and can-
not always be effectively treated with appropriate medical care. In many cases,
donors are either screened to reduce risks of these contaminations.
- Hepatitis A, Hepatitis C or Hepatitis E can be transmitted in blood; the
donor may be obviously ill at the time of donation.
http://en.wikipedia.org/wiki/Hepatitis_A
http://en.wikipedia.org/wiki/Hepatitis_C
http://en.wikipedia.org/wiki/Hepatitis_E
- Malaria - Donors in the United States and Europe are screened for travel to
malarial risk countries, and in Australia donors are tested for malaria.
http://en.wikipedia.org/wiki/Malaria
- Chagas Disease - A screening test has been implemented for this disease in
the United States, but is not yet required.
http://en.wikipedia.org/wiki/Chagas_Disease
- Babesiosis
http://en.wikipedia.org/wiki/Babesiosis
- Leishmaniasis
http://en.wikipedia.org/wiki/Leishmaniasis
- Simian foamy virus - While this virus can be transmitted by blood transfu-
sion, there is no evidence that it causes disease in humans.
http://en.wikipedia.org/wiki/Simian_foamy_virus
- Transfusion-related acute lung injury - A poorly understood syndrome which
is typically a response to products containing large amounts of plasma. Pro-
ducts collected from female donors who have had multiple children are at high
risk for this complication.
http://en.wikipedia.org/wiki/Transfusion-related_acute_lung_injury
- Myocardial ischaemia - if the patient has a non-ST-segment elevation acute
coronary syndromes (NSTE-ACS).
http://en.wikipedia.org/wiki/Myocardial_ischaemia
- Some medications may be transmitted in donated blood, and this is especially
a concern with pregnant women and medications such as Avodart and Propecia.
- vCJD or "Mad Cow Disease" has been shown to be transmissible in blood pro-
ducts. Potential donors who have spent time in the United Kingdom or Europe may
not be allowed to donate due to this risk.
http://en.wikipedia.org/wiki/VCJD
- Creutzfeldt-Jakob Disease or CJD is a separate disease from vCJD that is ex-
tremely rare.
http://en.wikipedia.org/wiki/Creutzfeldt-Jakob_Disease
- Bacterial contamination is a concern with any intravenous product, and is
especially problematic with blood products stored at room temperature (i.e.
platelets).
- Graft-versus-host disease is possible when blood of a close relative is
transfused. Donations from relatives are often irradiated to prevent this.
http://en.wikipedia.org/wiki/Graft-versus-host_disease
- Cytomegalovirus or CMV is a major problem for patients with compromised im-
mune systems and for neonates, but is not generally a concern for most recipi-
ents.
http://en.wikipedia.org/wiki/Cytomegalovirus
- Epstein-Barr Virus or EBV is very common, but rarely causes clinical symp-
toms.
http://en.wikipedia.org/wiki/Epstein-Barr_Virus
- Transfusion Associated Circulatory Overload (TACO) or excess iron are also
potential problems if a patient receives excessive transfusions.
Reduction of nitric oxide reduces the oxygen transmitting ability of stored
blood.
http://www.foxnews.com/story/0,2933,300327,00.html
